Matching Funds Request

Applicant:

First Name: Last Name: Address: City: County: State: Zip Code:

Applicant Agent:

First Name: Last Name: Address: City: County: State: Zip Code:

Project Information:

Project Name: Project Location: Project Description:
Briefly describe the project. Maps, drawings, photographs or other information can be emailed to wcwcd@sbcglobal.net after this form is submitted. Project Benefits:
Briefly describe the benefits to be realized if the project is implemented. Estimated Project Cost: Amount Requested from CTWCD: Sources of Other Funds:
List all other sources of funds to be used to match funds requested from CTWCD. List the provider of the matching funds and the amount requested from each provider. Estimated Start Date: Estimated Completion Date: Required Approvals:
List all permits, licenses and approvals required. Provide the current status of each approval required. If approval has not been requested or is in progress, provide the estimated date on which approval can be expected. Other Information:
Provide any information that may be important to the approval of this application. Certification of Accuracy:
I certify that I am familiar with the information contained in this application, and that to the best of my knowledge and belief, such information is true, complete and accurate. I further certify that I have the authority to undertake the proposed activity.
Check this box if you agree to the above.

Carson-Truckee Water Conservancy District

Matching Funds Request

Applicant:

Applicant Agent:

Project Information: